The treatment of open wounds that do not spontaneously close has long been a troublesome area of medical practice. These open wounds are a result of acute wounds, contaminated wounds, burns, extravasations and wound complications from failed surgery. Of those, necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. Combinations of aerobes, anaerobes and facultative microbial agents often act synergistically to produce skin and soft tissue infections. The anaerobes proliferate in an environment of local tissue hypoxia in patients following trauma, surgery or medical compromise. Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection, spreading through the deep fascial plane, with secondary necrosis of the subcutaneous tissues. This deep infection causes vascular occlusion, ischemia, and tissue necrosis. Superficial nerves are damaged, producing the characteristic localized loss of sensation. Most necrotizing soft tissue infections have anaerobic bacteria present, usually in combination with aerobic gram-negative organisms. They proliferate in an environment of local tissue hypoxia in those patients with trauma, recent surgery, or medical compromise. Type 1 Necrotizing Fasciitis is a mixed infection caused by aerobic and anaerobic bacteria, and appears most commonly following surgical procedures and in patients with peripheral vascular disease (PVD) and diabetes. Type 2 Necrotizing Fasciitis refers to a mono-microbial infection caused mainly by group A streptococcus pyogenes. Pathogenesis of NF is rapid and can lead to loss of an associated limb or life.
Once the diagnosis of NF is confirmed, treatment should be initiated without delay. Several existing therapies such as early and aggressive surgical debridement and exploration of necrotic tissue, administration of systemic antibiotics, hyperbaric oxygen (HBO) and intravenous immunoglobulin are used with mixed success.
An ideal treatment for NF, in particular when the infection is caused by anaerobic bacteria, is unavailable and significant amputations and deaths result each year from NF.